Ambulatory diagnostic ECG monitoring for syncope and collapse: An assessment of clinical practice in the United States

David G. Benditt, Wayne O. Adkisson, Richard Sutton, Robin K. Mears, Scott Sakaguchi

Research output: Contribution to journalArticle

Abstract

Introduction: Diagnostic ambulatory electrocardiogram (AECG) monitoring is widely used for evaluating syncope and collapse, and practice guidelines provide recommendations regarding optimal AECG device selection. However, whether physicians utilize AECGs in accordance with the pertinent guidelines is unclear. This study assessed utilization of AECG monitoring systems for syncope and collapse diagnosis by physicians in the United States. Methods and results: A quantitative survey was undertaken of physicians comprising multiple specialties (emergency department, n = 35; primary care, n = 35; hospitalists, n = 30; neurologists, n = 30; nonimplanting, n = 34, and implanting-cardiologists, n = 35). Depending on specialty, respondents reported that neural-reflex and orthostatic causes accounted for 17–23%, cardiac causes for 12–20%, and “neurological causes” (specifically psychogenic pseudo-syncope/pseudo-seizures and acute cerebrovascular conditions) for 7–12% of their syncope/collapse cases. The choice of AECG technology varied by specialty. Thus, despite patients having daily symptoms, 25% of respondents chose an AECG technology other than a Holter-type monitor. Conversely, when monitoring for infrequent events (e.g., less than monthly), 12–18% indicated that they would choose a 24- to 48-hour Holter, 20–34% would choose either a conventional event recorder or a mobile cardiac telemetry system, and only 53–65% would select an insertable cardiac monitor. Conclusions: In evaluation of syncope/collapse, most U.S. clinicians across specialties use AECGs appropriately, but in a substantial minority there remains discordance between choice of AECG technology and guideline-based recommendations.

LanguageEnglish (US)
Pages203-209
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume41
Issue number2
DOIs
StatePublished - Feb 1 2018

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Syncope
Electrocardiography
Ambulatory Monitoring
Technology
Physicians
Hospitalists
Guidelines
Telemetry
Practice Guidelines
Reflex
Hospital Emergency Service
Primary Health Care
Seizures
Equipment and Supplies
Surveys and Questionnaires

Keywords

  • ambulatory ECG monitoring
  • collapse
  • syncope

PubMed: MeSH publication types

  • Journal Article

Cite this

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title = "Ambulatory diagnostic ECG monitoring for syncope and collapse: An assessment of clinical practice in the United States",
abstract = "Introduction: Diagnostic ambulatory electrocardiogram (AECG) monitoring is widely used for evaluating syncope and collapse, and practice guidelines provide recommendations regarding optimal AECG device selection. However, whether physicians utilize AECGs in accordance with the pertinent guidelines is unclear. This study assessed utilization of AECG monitoring systems for syncope and collapse diagnosis by physicians in the United States. Methods and results: A quantitative survey was undertaken of physicians comprising multiple specialties (emergency department, n = 35; primary care, n = 35; hospitalists, n = 30; neurologists, n = 30; nonimplanting, n = 34, and implanting-cardiologists, n = 35). Depending on specialty, respondents reported that neural-reflex and orthostatic causes accounted for 17–23{\%}, cardiac causes for 12–20{\%}, and “neurological causes” (specifically psychogenic pseudo-syncope/pseudo-seizures and acute cerebrovascular conditions) for 7–12{\%} of their syncope/collapse cases. The choice of AECG technology varied by specialty. Thus, despite patients having daily symptoms, 25{\%} of respondents chose an AECG technology other than a Holter-type monitor. Conversely, when monitoring for infrequent events (e.g., less than monthly), 12–18{\%} indicated that they would choose a 24- to 48-hour Holter, 20–34{\%} would choose either a conventional event recorder or a mobile cardiac telemetry system, and only 53–65{\%} would select an insertable cardiac monitor. Conclusions: In evaluation of syncope/collapse, most U.S. clinicians across specialties use AECGs appropriately, but in a substantial minority there remains discordance between choice of AECG technology and guideline-based recommendations.",
keywords = "ambulatory ECG monitoring, collapse, syncope",
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AU - Benditt, David G.

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AU - Mears, Robin K.

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N2 - Introduction: Diagnostic ambulatory electrocardiogram (AECG) monitoring is widely used for evaluating syncope and collapse, and practice guidelines provide recommendations regarding optimal AECG device selection. However, whether physicians utilize AECGs in accordance with the pertinent guidelines is unclear. This study assessed utilization of AECG monitoring systems for syncope and collapse diagnosis by physicians in the United States. Methods and results: A quantitative survey was undertaken of physicians comprising multiple specialties (emergency department, n = 35; primary care, n = 35; hospitalists, n = 30; neurologists, n = 30; nonimplanting, n = 34, and implanting-cardiologists, n = 35). Depending on specialty, respondents reported that neural-reflex and orthostatic causes accounted for 17–23%, cardiac causes for 12–20%, and “neurological causes” (specifically psychogenic pseudo-syncope/pseudo-seizures and acute cerebrovascular conditions) for 7–12% of their syncope/collapse cases. The choice of AECG technology varied by specialty. Thus, despite patients having daily symptoms, 25% of respondents chose an AECG technology other than a Holter-type monitor. Conversely, when monitoring for infrequent events (e.g., less than monthly), 12–18% indicated that they would choose a 24- to 48-hour Holter, 20–34% would choose either a conventional event recorder or a mobile cardiac telemetry system, and only 53–65% would select an insertable cardiac monitor. Conclusions: In evaluation of syncope/collapse, most U.S. clinicians across specialties use AECGs appropriately, but in a substantial minority there remains discordance between choice of AECG technology and guideline-based recommendations.

AB - Introduction: Diagnostic ambulatory electrocardiogram (AECG) monitoring is widely used for evaluating syncope and collapse, and practice guidelines provide recommendations regarding optimal AECG device selection. However, whether physicians utilize AECGs in accordance with the pertinent guidelines is unclear. This study assessed utilization of AECG monitoring systems for syncope and collapse diagnosis by physicians in the United States. Methods and results: A quantitative survey was undertaken of physicians comprising multiple specialties (emergency department, n = 35; primary care, n = 35; hospitalists, n = 30; neurologists, n = 30; nonimplanting, n = 34, and implanting-cardiologists, n = 35). Depending on specialty, respondents reported that neural-reflex and orthostatic causes accounted for 17–23%, cardiac causes for 12–20%, and “neurological causes” (specifically psychogenic pseudo-syncope/pseudo-seizures and acute cerebrovascular conditions) for 7–12% of their syncope/collapse cases. The choice of AECG technology varied by specialty. Thus, despite patients having daily symptoms, 25% of respondents chose an AECG technology other than a Holter-type monitor. Conversely, when monitoring for infrequent events (e.g., less than monthly), 12–18% indicated that they would choose a 24- to 48-hour Holter, 20–34% would choose either a conventional event recorder or a mobile cardiac telemetry system, and only 53–65% would select an insertable cardiac monitor. Conclusions: In evaluation of syncope/collapse, most U.S. clinicians across specialties use AECGs appropriately, but in a substantial minority there remains discordance between choice of AECG technology and guideline-based recommendations.

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